Normal Transit Constipation
Constipated patients with normal colon transit and normal anorectal function often misperceive bowel frequency and exhibit increased psychological distress. It is important to reassure these patients that there is no evidence of abnormal function of the colon or rectum.
Patients should be educated to increase fluid and fiber intake, take advantage of gastrocolonic responses, and avoid excessive use of laxatives. We often screen these patients for underlying anxiety, depression or other psychological distress using a previously validated psychological symptom form, the SCL-90R. Pharmacotherapy to reduce underlying anxiety or depression may be helpful in some individuals. minimizing colon contents with periodic evacuations.
Initial disimpaction with colon cleansing is necessary for successful long term management.We prefer to institute a low fiber diet together with daily PEG solution to minimize stool and gas buildup and to keep stools soft. Twice weekly, a glycerine suppository or a tap water enema should be administered to prompt defecation.As a rule, these patients respond poorly to stimulant laxatives and prokinetic agents.
Occasionally, surgery may be indicated for chronic megacolon when bowel distension becomes too uncomfortable. In patients with megacolon and megarectum, a diverting ileostomy or ileoanal anastomosis may be considered. For megacolon with normal anorectal function, an ileorectal anastomosis may be appropriate whereas in megarectum with normal colon, a coloanal anastomosis, diverting colostomy, or Duhamel procedure may be effective.
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